Emergency Department-Initiated Hospice and Palliative Care Consultation Among Older Adults: Protocol for a Systematic Review and Meta-Analysis

Background: Emergency departments (EDs) play a critical role in caring for the aging population, particularly those nearing the end of life. Despite advances in integrating palliative care resources in the ED, targeted research on the impact of hospice and palliative care (HPC) consultations for older adults in ED settings remains limited. This systematic review protocol assesses the effects of ED-initiated HPC consultations on health outcomes and the quality of care for older adults. Objective: The objective of this systematic review is to synthesize the available evidence on the effectiveness of ED-initiated HPC consultations on the provision of advance care planning among older adults (≥60 years). Our review will focus on assessing several secondary outcomes, including mortality, hospital admissions, length of stay, repeat health service use, costs, and satisfaction levels among patients, caregivers, and clinicians. Methods: Following the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) reporting guidelines, our protocol outlines a comprehensive review of published studies. Systematic searches will be conducted in databases such as Medline, EMBASE, PubMed, Cochrane Trials database, and Web of Science from inception to present. Studies will be selected if they involve randomized, quasi-randomized, or observational designs examining the effectiveness of HPC interventions in the ED for older adults. Title, abstract and full text screening, risk of bias evaluation, and grading of the evidence will be completed independently and in duplicate by a group of emergency medicine and palliative care researchers. If feasible, a meta-analysis will be conducted using a random-effects model to evaluate the outlined outcomes. Results: We will report descriptive statistics to describe the body of literature and we will pool absolute risk differences along with corresponding 95% CIs. We will also report on study risk of bias and certainty of the evidence. Conclusions: Despite the rapid growth of emergency medicine and HPC literature, a focused systematic review on the geriatric ED population remains absent. Our work not only fills a vital gap in the literature related to ED-initiated HCP consultations for older adults, but it sets the stage for significant future advancements in the care of older adults in the ED.